Imaging of Patients Suspected of SLAP Tear: A Cost-Effectiveness Study

Gyftopoulos, Soterios; Conroy, Jordan; Koo, James; Jones, Morgan; Miniaci, Anthony; Subhas, Naveen

doi:10.2214/ajr.21.26420

Cited by 7 publications

(7 citation statements)

References 48 publications

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“…Most studies were performed in the United States (n = 15, 83.3%), two were from Canada and one was from Australia. The clinical setting of included studies was distributed across primary care [18][19][20][21][22], outpatient orthopaedic clinics [21,[23][24][25][26][27][28][29], and emergency departments [30][31][32][33][34], with one study set in a rheumatology clinic [35].…”

Section: Resultsmentioning

confidence: 99%

“…Magnetic resonance imaging (MRI) was most commonly investigated (n = 13, 72.2%), including three studies for back complaints [18,25,35], three studies for neck complaints [31,33,34], and seven studies for knee [21,23,27] and shoulder [24,26,28,29] complaints. Computed tomography and x-ray were only investigated in studies of back and neck complaints [18-20, 22, 25, 30, 32, 35].…”

Section: Resultsmentioning

confidence: 99%

“…Computed tomography and x-ray were only investigated in studies of back and neck complaints [18-20, 22, 25, 30, 32, 35]. Two studies focused on ultrasound [24,28] and two studies on arthrography [26,29] for shoulder complaints.…”

Section: Resultsmentioning

confidence: 99%

“…For the third theme, a clear test-surgery pathway was outlined in eight studies [21,[23][24][25][26][27][28][29], including all seven studies for knee and shoulder complaints. Four studies did not specify the treatment that was provided following the imaging test yet included patient health outcomes [20,[30][31][32].…”

Section: Summary Of Study Objectivesmentioning

confidence: 99%

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Use of Decision-Analytic Modelling to Assess the Cost-Effectiveness of Diagnostic Imaging of the Spine, Shoulder, and Knee: A Scoping Review

Docking

Dunstan

Ademi

et al. 2023

Appl Health Econ Health Policy

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Background Limited evidence is available on the cost-effectiveness of diagnostic imaging for back, neck, knee, and shoulder complaints. Decision analytic modelling may be an appropriate method to synthesise evidence from multiple sources, and overcomes issues with trial-based economic evaluations. Objective The aim was to describe the reporting of methods and objectives utilised in existing decision analytic modelling studies that assess the cost-effectiveness of diagnostic imaging for back, neck, knee, and shoulder complaints. Methods Decision analytic modelling studies investigating the use of any imaging modality for people of any age with back, neck, knee, or shoulder complaints were included. No restrictions on comparators were applied, and included studies were required to estimate both costs and benefits. A systematic search (5 January 2023) of four databases was conducted with no date limits imposed. Methodological and knowledge gaps were identified through a narrative summary. Results Eighteen studies were included. Methodological issues were identified relating to the poor reporting of methods, and measures of effectiveness did not incorporate changes in quantity and/or quality of life (cost-utility analysis in only ten of 18 studies). Included studies, particularly those investigating back or neck complaints, focused on conditions that were of low prevalence but have a serious impact on health (i.e. cervical spine trauma, cancer-related back pain). Conclusions Future models should pay particular attention to the identified methodological and knowledge gaps. Investment in the health technology assessment of these commonly utilised diagnostic imaging services is needed to justify the current level of utilisation and ensure that these services represent value for money. Key Points for Decision MakersThere is a paucity of high-quality modelling studies investigating the cost-effectiveness of diagnostic imaging for common musculoskeletal complaints despite its widespread use.There are few high-quality modelling studies that adhere to modelling guidelines, limiting our understanding of whether diagnostic imaging for back, neck, knee, and shoulder complaints represent value for money.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Summary Of Study Objectivesmentioning

confidence: 99%

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Use of Decision-Analytic Modelling to Assess the Cost-Effectiveness of Diagnostic Imaging of the Spine, Shoulder, and Knee: A Scoping Review

Docking

Dunstan

Ademi

et al. 2023

Appl Health Econ Health Policy

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“…A decision analytic model from the healthcare system perspective [25][26][27][28] was used to determine the cost-effectiveness of the two most common treatment strategies for first-time shoulder dislocation patients: ABR and nonoperative management. The primary effectiveness outcome was measured in quality-adjusted life-years (QALYs).…”

Section: Methodsmentioning

confidence: 99%

Arthroscopic Bankart repair versus nonoperative management for first-time anterior shoulder instability: A cost-effectiveness analysis

Li,

Hurley,

Garra

et al. 2023

Shoulder & Elbow

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Purpose Arthroscopic Bankart repair (ABR) may be more effective than nonoperative management for patients with anterior shoulder instability following first-time dislocation. The purpose of the study was to determine the most cost-effective treatment strategy by evaluating the incremental cost-effectiveness ratio (ICER) for ABR versus nonoperative treatment. Methods This cost-effectiveness study utilized a Markov decision chain and Monte Carlo simulation. Probabilities, health utility values, and outcome data regarding ABR and nonoperative management of first-time shoulder instability derived from level I/II evidence. Costs were tabulated from Centers for Medicaid & Medicare Services. Probabilistic sensitivity analysis was performed using >100,000 repetitions of the Monte Carlo simulation. A willingness-to-pay (WTP) threshold was set at $50,000. Results The expected cost for operative management higher than nonoperative management ($32,765 vs $29,343). However, ABR (5.48 quality-adjusted life years (QALYs)) was the more effective treatment strategy compared to nonoperative management (4.61 QALYs). The ICER for ABR was $3943. Probabilistic sensitivity analysis showed that ABR was the most cost-effective strategy in 100% of simulations. Discussion ABR is more cost-effective than nonoperative management for first-time anterior shoulder dislocation. The threshold analysis demonstrated that when accounting for WTP, ABR was found to be the more cost-effective strategy.

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SSR white paper: guidelines for utilization and performance of direct MR arthrography

Chang,

Bencardino,

French

et al. 2023

Skeletal Radiol

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Objective Direct magnetic resonance arthrography (dMRA) is often considered the most accurate imaging modality for the evaluation of intra-articular structures, but utilization and performance vary widely without consensus. The purpose of this white paper is to develop consensus recommendations on behalf of the Society of Skeletal Radiology (SSR) based on published literature and expert opinion. Materials and methods The Standards and Guidelines Committee of the SSR identified guidelines for utilization and performance of dMRA as an important topic for study and invited all SSR members with expertise and interest to volunteer for the white paper panel. This panel was tasked with determining an outline, reviewing the relevant literature, preparing a written document summarizing the issues and controversies, and providing recommendations. Results Twelve SSR members with expertise in dMRA formed the ad hoc white paper authorship committee. The published literature on dMRA was reviewed and summarized, focusing on clinical indications, technical considerations, safety, imaging protocols, complications, controversies, and gaps in knowledge. Recommendations for the utilization and performance of dMRA in the shoulder, elbow, wrist, hip, knee, and ankle/foot regions were developed in group consensus. Conclusion Although direct MR arthrography has been previously used for a wide variety of clinical indications, the authorship panel recommends more selective application of this minimally invasive procedure. At present, direct MR arthrography remains an important procedure in the armamentarium of the musculoskeletal radiologist and is especially valuable when conventional MRI is indeterminant or results are discrepant with clinical evaluation.

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Imaging of Patients Suspected of SLAP Tear: A Cost-Effectiveness Study

Cited by 7 publications

References 48 publications

Use of Decision-Analytic Modelling to Assess the Cost-Effectiveness of Diagnostic Imaging of the Spine, Shoulder, and Knee: A Scoping Review

Use of Decision-Analytic Modelling to Assess the Cost-Effectiveness of Diagnostic Imaging of the Spine, Shoulder, and Knee: A Scoping Review

Arthroscopic Bankart repair versus nonoperative management for first-time anterior shoulder instability: A cost-effectiveness analysis

SSR white paper: guidelines for utilization and performance of direct MR arthrography

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